|
||||||||||||||||||||||
|
||||||||||||||||||||||
|
||||||||||||||||||||||
| ||||||||||||||||||||||
1 | AN ACT concerning insurance.
| |||||||||||||||||||||
2 | Be it enacted by the People of the State of Illinois,
| |||||||||||||||||||||
3 | represented in the General Assembly:
| |||||||||||||||||||||
4 | Section 5. The Comprehensive Health Insurance Plan Act is | |||||||||||||||||||||
5 | amended by changing Sections 2 and 12 as follows: | |||||||||||||||||||||
6 | (215 ILCS 105/2) (from Ch. 73, par. 1302) | |||||||||||||||||||||
7 | Sec. 2. Definitions. As used in this Act, unless the | |||||||||||||||||||||
8 | context otherwise
requires:
| |||||||||||||||||||||
9 | "Plan administrator" means the insurer or third party
| |||||||||||||||||||||
10 | administrator designated under Section 5 of this Act.
| |||||||||||||||||||||
11 | "Benefits plan" means the coverage to be offered by the | |||||||||||||||||||||
12 | Plan to
eligible persons and federally eligible individuals | |||||||||||||||||||||
13 | pursuant to this Act.
| |||||||||||||||||||||
14 | "Board" means the Illinois Comprehensive Health Insurance | |||||||||||||||||||||
15 | Board.
| |||||||||||||||||||||
16 | "Church plan" has the same meaning given that term in the | |||||||||||||||||||||
17 | federal Health
Insurance Portability and Accountability Act of | |||||||||||||||||||||
18 | 1996.
| |||||||||||||||||||||
19 | "Continuation coverage" means continuation of coverage | |||||||||||||||||||||
20 | under a group health
plan or other health insurance coverage | |||||||||||||||||||||
21 | for former employees or dependents of
former employees that | |||||||||||||||||||||
22 | would otherwise have terminated under the terms of that
| |||||||||||||||||||||
23 | coverage pursuant to any continuation provisions under federal | |||||||||||||||||||||
24 | or State law,
including the Consolidated Omnibus Budget | |||||||||||||||||||||
25 | Reconciliation Act of 1985 (COBRA),
as amended, Sections 367.2, | |||||||||||||||||||||
26 | 367e, and 367e.1 of the Illinois Insurance Code, or
any
other | |||||||||||||||||||||
27 | similar requirement in another State.
| |||||||||||||||||||||
28 | "Covered person" means a person who is and continues to | |||||||||||||||||||||
29 | remain eligible for
Plan coverage and is covered under one of | |||||||||||||||||||||
30 | the benefit plans offered by the
Plan.
| |||||||||||||||||||||
31 | "Creditable coverage" means, with respect to a federally | |||||||||||||||||||||
32 | eligible
individual, coverage of the individual under any of |
| |||||||
|
|||||||
1 | the following:
| ||||||
2 | (A) A group health plan.
| ||||||
3 | (B) Health insurance coverage (including group health | ||||||
4 | insurance coverage).
| ||||||
5 | (C) Medicare.
| ||||||
6 | (D) Medical assistance.
| ||||||
7 | (E) Chapter 55 of title 10, United States Code.
| ||||||
8 | (F) A medical care program of the Indian Health Service | ||||||
9 | or of a tribal
organization.
| ||||||
10 | (G) A state health benefits risk pool.
| ||||||
11 | (H) A health plan offered under Chapter 89 of title 5, | ||||||
12 | United States Code.
| ||||||
13 | (I) A public health plan (as defined in regulations | ||||||
14 | consistent with
Section
104 of the Health Care Portability | ||||||
15 | and Accountability Act of 1996 that may be
promulgated by | ||||||
16 | the Secretary of the U.S. Department of Health and Human
| ||||||
17 | Services).
| ||||||
18 | (J) A health benefit plan under Section 5(e) of the | ||||||
19 | Peace Corps Act (22
U.S.C. 2504(e)).
| ||||||
20 | (K) Any other qualifying coverage required by the | ||||||
21 | federal Health Insurance
Portability and Accountability | ||||||
22 | Act of 1996, as it may be amended, or
regulations under | ||||||
23 | that
Act.
| ||||||
24 | "Creditable coverage" does not include coverage consisting | ||||||
25 | solely of coverage
of excepted benefits, as defined in Section | ||||||
26 | 2791(c) of title XXVII of
the
Public Health Service Act (42 | ||||||
27 | U.S.C. 300 gg-91), nor does it include any
period
of coverage | ||||||
28 | under any of items (A) through (K) that occurred before a break | ||||||
29 | of
more than 90 days or, if the individual has
been certified | ||||||
30 | as eligible pursuant to the federal Trade Act
of 2002, a
break | ||||||
31 | of more than 63 days during all of which the individual was not | ||||||
32 | covered
under any of items (A) through (K) above.
| ||||||
33 | Any period that an individual is in a waiting period for
| ||||||
34 | any coverage under a group health plan (or for group health | ||||||
35 | insurance
coverage) or is in an affiliation period under the | ||||||
36 | terms of health insurance
coverage offered by a health |
| |||||||
|
|||||||
1 | maintenance organization shall not be taken into
account in | ||||||
2 | determining if there has been a break of more than 90
days in | ||||||
3 | any
creditable coverage.
| ||||||
4 | "Department" means the Illinois Department of Insurance.
| ||||||
5 | "Dependent" means an Illinois resident: who is a spouse; or | ||||||
6 | who is claimed
as a dependent by the principal insured for | ||||||
7 | purposes of filing a federal income
tax return and resides in | ||||||
8 | the principal insured's household, and is a resident
unmarried | ||||||
9 | child under the age of 19 years; or who is an unmarried child | ||||||
10 | who
also is a full-time student under the age of 23 years and | ||||||
11 | who is financially
dependent upon the principal insured; or who | ||||||
12 | is a child of any age and who is
disabled and financially | ||||||
13 | dependent upon the
principal insured.
| ||||||
14 | "Direct Illinois premiums" means, for Illinois business, | ||||||
15 | an insurer's direct
premium income for the kinds of business | ||||||
16 | described in clause (b) of Class 1 or
clause (a) of Class 2 of | ||||||
17 | Section 4 of the Illinois Insurance Code, and direct
premium | ||||||
18 | income of a health maintenance organization or a voluntary | ||||||
19 | health
services plan, except it shall not include credit health | ||||||
20 | insurance as defined
in Article IX 1/2 of the Illinois | ||||||
21 | Insurance Code.
| ||||||
22 | "Director" means the Director of the Illinois Department of | ||||||
23 | Insurance.
| ||||||
24 | "Eligible person" means a resident of this State who | ||||||
25 | qualifies
for Plan coverage under Section 7 of this Act.
| ||||||
26 | "Employee" means a resident of this State who is employed | ||||||
27 | by an employer
or has entered into
the employment of or works | ||||||
28 | under contract or service of an employer
including the | ||||||
29 | officers, managers and employees of subsidiary or affiliated
| ||||||
30 | corporations and the individual proprietors, partners and | ||||||
31 | employees of
affiliated individuals and firms when the business | ||||||
32 | of the subsidiary or
affiliated corporations, firms or | ||||||
33 | individuals is controlled by a common
employer through stock | ||||||
34 | ownership, contract, or otherwise.
| ||||||
35 | "Employer" means any individual, partnership, association, | ||||||
36 | corporation,
business trust, or any person or group of persons |
| |||||||
|
|||||||
1 | acting directly or indirectly
in the interest of an employer in | ||||||
2 | relation to an employee, for which one or
more
persons is | ||||||
3 | gainfully employed.
| ||||||
4 | "Family" coverage means the coverage provided by the Plan | ||||||
5 | for the
covered person and his or her eligible dependents who | ||||||
6 | also are
covered persons.
| ||||||
7 | "Federally eligible individual" means an individual | ||||||
8 | resident of this State:
| ||||||
9 | (1)(A) for whom, as of the date on which the individual | ||||||
10 | seeks Plan
coverage
under Section 15 of this Act, the | ||||||
11 | aggregate of the periods of creditable
coverage is 18 or | ||||||
12 | more months or, if the individual has been
certified as
| ||||||
13 | eligible pursuant to the federal Trade Act of 2002,
3 or | ||||||
14 | more
months, and (B) whose most recent prior creditable
| ||||||
15 | coverage was under group health insurance coverage offered | ||||||
16 | by a health
insurance issuer, a group health plan, a | ||||||
17 | governmental plan, or a church plan
(or
health insurance | ||||||
18 | coverage offered in connection with any such plans) or any
| ||||||
19 | other type of creditable coverage that may be required by | ||||||
20 | the federal Health
Insurance Portability
and | ||||||
21 | Accountability Act of 1996, as it may be amended, or the | ||||||
22 | regulations
under that Act;
| ||||||
23 | (2) who
is not eligible for coverage under
(A) a group | ||||||
24 | health plan
(other than an individual who has been | ||||||
25 | certified as eligible
pursuant to the federal Trade Act of | ||||||
26 | 2002), (B)
part
A or part B of Medicare due to age
(other | ||||||
27 | than an individual who has been certified as eligible
| ||||||
28 | pursuant to the federal Trade Act of 2002), or (C) medical | ||||||
29 | assistance, and
does not
have other
health insurance | ||||||
30 | coverage (other than an individual who has been certified | ||||||
31 | as
eligible pursuant to the federal Trade Act of 2002);
| ||||||
32 | (3) with respect to whom (other than an individual who | ||||||
33 | has been
certified as eligible pursuant to the federal | ||||||
34 | Trade Act of 2002) the most
recent coverage within the | ||||||
35 | coverage
period
described in paragraph (1)(A) of this | ||||||
36 | definition was not terminated
based upon a factor relating |
| |||||||
|
|||||||
1 | to nonpayment of premiums or fraud;
| ||||||
2 | (4) if the individual (other than an individual who has
| ||||||
3 | been certified
as eligible pursuant to the federal Trade | ||||||
4 | Act
of 2002)
had been offered the option of continuation
| ||||||
5 | coverage
under a COBRA continuation provision or under a | ||||||
6 | similar State program, who
elected such coverage; and
| ||||||
7 | (5) who, if the individual elected such continuation | ||||||
8 | coverage, has
exhausted
such continuation coverage under | ||||||
9 | such provision or program.
| ||||||
10 | However, an individual who has been certified as
eligible
| ||||||
11 | pursuant to the
federal Trade Act of 2002
shall not be required | ||||||
12 | to elect
continuation
coverage under a COBRA continuation | ||||||
13 | provision or under a similar state
program.
| ||||||
14 | "Group health insurance coverage" means, in connection | ||||||
15 | with a group health
plan, health insurance coverage offered in | ||||||
16 | connection with that plan.
| ||||||
17 | "Group health plan" has the same meaning given that term in | ||||||
18 | the federal
Health
Insurance Portability and Accountability | ||||||
19 | Act of 1996.
| ||||||
20 | "Governmental plan" has the same meaning given that term in | ||||||
21 | the federal
Health
Insurance Portability and Accountability | ||||||
22 | Act of 1996.
| ||||||
23 | "Health insurance coverage" means benefits consisting of | ||||||
24 | medical care
(provided directly, through insurance or | ||||||
25 | reimbursement, or otherwise and
including items and services | ||||||
26 | paid for as medical care) under any hospital and
medical | ||||||
27 | expense-incurred policy,
certificate, or
contract provided by | ||||||
28 | an insurer, non-profit health care service plan
contract, | ||||||
29 | health maintenance organization or other subscriber contract, | ||||||
30 | or
any other health care plan or arrangement that pays for or | ||||||
31 | furnishes
medical or health care services whether by
insurance | ||||||
32 | or otherwise. Health insurance coverage shall not include short
| ||||||
33 | term,
accident only,
disability income, hospital confinement | ||||||
34 | or fixed indemnity, dental only,
vision only, limited benefit, | ||||||
35 | or credit
insurance, coverage issued as a supplement to | ||||||
36 | liability insurance,
insurance arising out of a workers' |
| |||||||
|
|||||||
1 | compensation or similar law, automobile
medical-payment | ||||||
2 | insurance, or insurance under which benefits are payable
with | ||||||
3 | or without regard to fault and which is statutorily required to | ||||||
4 | be
contained in any liability insurance policy or equivalent | ||||||
5 | self-insurance.
| ||||||
6 | "Health insurance issuer" means an insurance company, | ||||||
7 | insurance service,
or insurance organization (including a | ||||||
8 | health maintenance organization and a
voluntary health | ||||||
9 | services plan) that is authorized to transact health
insurance
| ||||||
10 | business in this State. Such term does not include a group | ||||||
11 | health plan.
| ||||||
12 | "Health Maintenance Organization" means an organization as
| ||||||
13 | defined in the Health Maintenance Organization Act.
| ||||||
14 | "Hospice" means a program as defined in and licensed under | ||||||
15 | the
Hospice Program Licensing Act.
| ||||||
16 | "Hospital" means a duly licensed institution as defined in | ||||||
17 | the
Hospital Licensing Act,
an institution that meets all | ||||||
18 | comparable conditions and requirements in
effect in the state | ||||||
19 | in which it is located, or the University of Illinois
Hospital | ||||||
20 | as defined in the University of Illinois Hospital Act.
| ||||||
21 | "Individual health insurance coverage" means health | ||||||
22 | insurance coverage
offered to individuals in the individual | ||||||
23 | market, but does not include
short-term, limited-duration | ||||||
24 | insurance.
| ||||||
25 | "Insured" means any individual resident of this State who | ||||||
26 | is
eligible to receive benefits from any insurer (including | ||||||
27 | health insurance
coverage offered in connection with a group | ||||||
28 | health plan) or health
insurance issuer as
defined in this | ||||||
29 | Section.
| ||||||
30 | "Insurer" means any insurance company authorized to | ||||||
31 | transact health
insurance business in this State and any | ||||||
32 | corporation that provides medical
services and is organized | ||||||
33 | under the Voluntary Health Services Plans Act or
the Health | ||||||
34 | Maintenance Organization
Act.
"Insurer" also includes any | ||||||
35 | self-insurance arrangement covered by stop-loss insurance that | ||||||
36 | provides health care benefits in this State.
|
| |||||||
|
|||||||
1 | "Medical assistance" means the State medical assistance or | ||||||
2 | medical
assistance no grant (MANG) programs provided under
| ||||||
3 | Title XIX of the Social Security Act and
Articles V (Medical | ||||||
4 | Assistance) and VI (General Assistance) of the Illinois
Public | ||||||
5 | Aid Code (or any successor program) or under any
similar | ||||||
6 | program of health care benefits in a state other than Illinois.
| ||||||
7 | "Medically necessary" means that a service, drug, or supply | ||||||
8 | is
necessary and appropriate for the diagnosis or treatment of | ||||||
9 | an illness or
injury in accord with generally accepted | ||||||
10 | standards of medical practice at
the time the service, drug, or | ||||||
11 | supply is provided. When specifically
applied to a confinement | ||||||
12 | it further means that the diagnosis or treatment
of the covered | ||||||
13 | person's medical symptoms or condition cannot be
safely
| ||||||
14 | provided to that person as an outpatient. A service, drug, or | ||||||
15 | supply shall
not be medically necessary if it: (i) is | ||||||
16 | investigational, experimental, or
for research purposes; or | ||||||
17 | (ii) is provided solely for the convenience of
the patient, the | ||||||
18 | patient's family, physician, hospital, or any other
provider; | ||||||
19 | or (iii) exceeds in scope, duration, or intensity that level of
| ||||||
20 | care that is needed to provide safe, adequate, and appropriate | ||||||
21 | diagnosis or
treatment; or (iv) could have been omitted without | ||||||
22 | adversely affecting the
covered person's condition or the | ||||||
23 | quality of medical care; or
(v) involves
the use of a medical | ||||||
24 | device, drug, or substance not formally approved by
the United | ||||||
25 | States Food and Drug Administration.
| ||||||
26 | "Medical care" means the ordinary and usual professional | ||||||
27 | services rendered
by a physician or other specified provider | ||||||
28 | during a professional visit for
treatment of an illness or | ||||||
29 | injury.
| ||||||
30 | "Medicare" means coverage under both Part A and Part B of | ||||||
31 | Title XVIII of
the Social Security
Act, 42 U.S.C. Sec. 1395, et | ||||||
32 | seq.
| ||||||
33 | "Minimum premium plan" means an arrangement whereby a | ||||||
34 | specified
amount of health care claims is self-funded, but the | ||||||
35 | insurance company
assumes the risk that claims will exceed that | ||||||
36 | amount.
|
| |||||||
|
|||||||
1 | "Participating transplant center" means a hospital | ||||||
2 | designated by the
Board as a preferred or exclusive provider of | ||||||
3 | services for one or more
specified human organ or tissue | ||||||
4 | transplants for which the hospital has
signed an agreement with | ||||||
5 | the Board to accept a transplant payment allowance
for all | ||||||
6 | expenses related to the transplant during a transplant benefit | ||||||
7 | period.
| ||||||
8 | "Physician" means a person licensed to practice medicine | ||||||
9 | pursuant to
the Medical Practice Act of 1987.
| ||||||
10 | "Plan" means the Comprehensive Health Insurance Plan
| ||||||
11 | established by this Act.
| ||||||
12 | "Plan of operation" means the plan of operation of the
| ||||||
13 | Plan, including articles, bylaws and operating rules, adopted | ||||||
14 | by the board
pursuant to this Act.
| ||||||
15 | "Provider" means any hospital, skilled nursing facility, | ||||||
16 | hospice, home
health agency, physician, registered pharmacist | ||||||
17 | acting within the scope of that
registration, or any other | ||||||
18 | person or entity licensed in Illinois to furnish
medical care.
| ||||||
19 | "Qualified high risk pool" has the same meaning given that | ||||||
20 | term in the
federal Health
Insurance Portability and | ||||||
21 | Accountability Act of 1996.
| ||||||
22 | "Resident" means a person who is and continues to be | ||||||
23 | legally domiciled
and physically residing on a permanent and | ||||||
24 | full-time basis in a
place of permanent habitation
in this | ||||||
25 | State
that remains that person's principal residence and from | ||||||
26 | which that person is
absent only for temporary or transitory | ||||||
27 | purpose.
| ||||||
28 | "Skilled nursing facility" means a facility or that portion | ||||||
29 | of a facility
that is licensed by the Illinois Department of | ||||||
30 | Public Health under the
Nursing Home Care Act or a comparable | ||||||
31 | licensing authority in another state
to provide skilled nursing | ||||||
32 | care.
| ||||||
33 | "Stop-loss coverage" means an arrangement whereby an | ||||||
34 | insurer
insures against the risk that any one claim will exceed | ||||||
35 | a specific dollar
amount or that the entire loss of a | ||||||
36 | self-insurance plan will exceed
a specific amount.
|
| |||||||
|
|||||||
1 | "Third party administrator" means an administrator as | ||||||
2 | defined in
Section 511.101 of the Illinois Insurance Code who | ||||||
3 | is licensed under
Article XXXI 1/4 of that Code.
| ||||||
4 | (Source: P.A. 92-153, eff. 7-25-01; 93-33, eff. 6-23-03; 93-34, | ||||||
5 | eff. 6-23-03; 93-477, eff. 8-8-03; 93-622, eff. 12-18-03.)
| ||||||
6 | (215 ILCS 105/12) (from Ch. 73, par. 1312)
| ||||||
7 | Sec. 12. Deficit or surplus.
| ||||||
8 | a. If premiums or other receipts by the
Board exceed the | ||||||
9 | amount required for the
operation
of the Plan, including actual | ||||||
10 | losses and administrative
expenses of the Plan, the Board shall | ||||||
11 | direct that the excess be held at
interest, in a bank | ||||||
12 | designated by the Board, or used to offset future
losses or to | ||||||
13 | reduce Plan premiums. In this
subsection, the term "future | ||||||
14 | losses" includes reserves for incurred but not
reported claims.
| ||||||
15 | b. Any deficit incurred or expected to be incurred on | ||||||
16 | behalf of eligible
persons who qualify for plan coverage under | ||||||
17 | Section 7 of this Act shall be
recouped by an
appropriation | ||||||
18 | made by the General Assembly.
| ||||||
19 | c. For the purposes of this Section, a deficit shall be | ||||||
20 | incurred when
anticipated losses and incurred but not reported | ||||||
21 | claims expenses exceed
anticipated income from earned premiums | ||||||
22 | net of administrative expenses.
| ||||||
23 | d. Any deficit incurred or expected to be incurred on | ||||||
24 | behalf of federally
eligible individuals who qualify for Plan | ||||||
25 | coverage under Section 15 of this Act
shall be recouped by an | ||||||
26 | assessment of all insurers made in accordance with the
| ||||||
27 | provisions of this Section. The Board shall within 90 days of | ||||||
28 | the effective
date of this amendatory Act of 1997 and within
| ||||||
29 | the first quarter of each fiscal
year thereafter assess all | ||||||
30 | insurers for the anticipated deficit in accordance
with the | ||||||
31 | provisions of this Section. The board may also make additional
| ||||||
32 | assessments no more than 4 times a year to fund unanticipated | ||||||
33 | deficits,
implementation expenses, and cash flow needs.
| ||||||
34 | (1) Each insurer's assessment shall be determined by | ||||||
35 | multiplying the total
amount to be assessed by a fraction, |
| |||||||
|
|||||||
1 | the numerator of which equals the number of Illinois | ||||||
2 | insureds and certificate holders insured, reinsured, or | ||||||
3 | covered, either directly or indirectly, by each insurer, | ||||||
4 | and the denominator of which equals the total of all | ||||||
5 | Illinois insureds and certificate holders insured, | ||||||
6 | reinsured, or covered, either directly or indirectly, by | ||||||
7 | all insurers, all determined as of the end of the prior | ||||||
8 | calendar year;
| ||||||
9 | (2) The Plan shall ensure that each insured and | ||||||
10 | certificate holder is counted
only once with respect to any | ||||||
11 | assessment. For that purpose, the Plan shall require each | ||||||
12 | insurer that obtains reinsurance of its insureds and | ||||||
13 | certificate holders to include in its count of insureds and | ||||||
14 | certificate holders all insureds and certificate holders | ||||||
15 | whose coverage is reinsured in whole or part. The Plan | ||||||
16 | shall allow an insurer who is a reinsurer to exclude from | ||||||
17 | its number of insureds those that have been counted by the | ||||||
18 | primary insurer or the primary reinsurer for the purpose of | ||||||
19 | determining its assessment under this subsection; | ||||||
20 | (3) Each insurer shall pay its assessment as required | ||||||
21 | by the Plan; | ||||||
22 | (4) If assessments exceed the amounts actually needed, | ||||||
23 | the excess shall be held and invested and, with the | ||||||
24 | earnings and interest, used by the Plan to offset future | ||||||
25 | net losses or to reduce pool premiums. For purposes of this | ||||||
26 | subsection, future net losses include reserves for | ||||||
27 | incurred but not reported claims; | ||||||
28 | e. An insurer's assessment shall be determined by | ||||||
29 | multiplying the total
assessment, as determined in subsection | ||||||
30 | d. of this Section, by a fraction, the
numerator of which | ||||||
31 | equals that insurer's direct Illinois premiums during the
| ||||||
32 | preceding calendar year and the denominator of which equals the | ||||||
33 | total of all
insurers' direct Illinois premiums. The Board may | ||||||
34 | exempt those insurers whose
share as determined under this | ||||||
35 | subsection would be so minimal as to not exceed
the estimated | ||||||
36 | cost of levying the assessment.
|
| |||||||
|
|||||||
1 | f. The Board shall charge and collect from each insurer the | ||||||
2 | amounts
determined to be due under this Section. The assessment | ||||||
3 | shall be billed by
Board invoice based upon the insurer's | ||||||
4 | direct Illinois premium income as shown
in its annual
statement | ||||||
5 | for the preceding calendar year as filed with the Director. The
| ||||||
6 | invoice shall be due upon
receipt and must be paid no later | ||||||
7 | than 30 days after receipt by the insurer.
| ||||||
8 | g. When an insurer fails to pay the full amount of any | ||||||
9 | assessment of $100 or
more
due under this Section there shall | ||||||
10 | be added to the amount due as a penalty the
greater of $50 or an | ||||||
11 | amount equal to 5% of the deficiency for each month or
part of | ||||||
12 | a month that the deficiency remains unpaid.
| ||||||
13 | h. Amounts collected under this Section shall be paid to | ||||||
14 | the Board for
deposit into the Plan Fund authorized by Section | ||||||
15 | 3 of this Act.
| ||||||
16 | i. An insurer may petition the Director for an abatement or | ||||||
17 | deferment of
all or part of an assessment imposed by the Board. | ||||||
18 | The Director may abate or
defer, in whole or in part, the | ||||||
19 | assessment if, in the opinion of the Director,
payment of the | ||||||
20 | assessment would endanger the ability of the insurer to fulfill
| ||||||
21 | its contractual obligations. In the event an assessment against | ||||||
22 | an insurer is
abated or deferred in whole or in part, the | ||||||
23 | amount by which the assessment is
abated or deferred shall be | ||||||
24 | assessed against the other insurers in a manner
consistent with | ||||||
25 | the basis for assessments set forth in this subsection. The
| ||||||
26 | insurer receiving a deferment shall remain liable to the plan | ||||||
27 | for the
deficiency for 4 years.
| ||||||
28 | j. The board shall establish procedures for appeal by any | ||||||
29 | insurer subject
to assessment pursuant to this
Section. Such | ||||||
30 | procedures shall require that:
| ||||||
31 | (1) Any insurer that wishes to appeal all or any part | ||||||
32 | of an assessment
made pursuant to this Section shall first | ||||||
33 | pay the amount of the assessment as
set forth in the | ||||||
34 | invoice provided by the board within the time provided in
| ||||||
35 | subsection f. of this Section.
The board shall hold such | ||||||
36 | payments
in a separate interest-bearing account.
The |
| |||||||
|
|||||||
1 | payments shall be accompanied by a
statement in writing | ||||||
2 | that the payment is made under appeal.
The statement
shall | ||||||
3 | specify the grounds for the appeal.
The insurer may be | ||||||
4 | represented in its appeal by counsel or other | ||||||
5 | representative
of its choosing.
| ||||||
6 | (2) Within 90 days following the payment of an | ||||||
7 | assessment under appeal by
any insurer, the board shall | ||||||
8 | notify the insurer or representative designated by
the | ||||||
9 | insurer in writing of its determination with respect to the | ||||||
10 | appeal
and the basis or bases for that determination unless
| ||||||
11 | the Board notifies the insurer that
a reasonable amount of | ||||||
12 | additional
time is required to resolve the issues raised by | ||||||
13 | the appeal.
| ||||||
14 | (3) The board shall refer to the Director any question | ||||||
15 | concerning the
amount of direct Illinois premium income as | ||||||
16 | shown in an insurer's annual
statement for the preceding | ||||||
17 | calendar year on file with the Director on the
invoice date | ||||||
18 | of the assessment. Unless additional time is required to | ||||||
19 | resolve
the question, the Director shall within 60 days | ||||||
20 | report to the board in writing
his determination respecting | ||||||
21 | the amount of direct Illinois premium income on
file on the | ||||||
22 | invoice date of the assessment.
| ||||||
23 | (4) In the event the board determines that the insurer | ||||||
24 | is entitled to a
refund, the refund shall be paid within 30 | ||||||
25 | days following the date upon which
the board makes its | ||||||
26 | determination, together with the accrued interest.
| ||||||
27 | Interest on any
refund due an insurer shall be paid at the | ||||||
28 | rate actually earned by the Board on
the separate account.
| ||||||
29 | (5) The amount of any such refund shall then be | ||||||
30 | assessed against all
insurers in a manner consistent with | ||||||
31 | the basis for assessment as otherwise
authorized
by this | ||||||
32 | Section.
| ||||||
33 | (6) The board's determination with respect to any | ||||||
34 | appeal received pursuant
to this subsection shall be a | ||||||
35 | final administrative decision as defined in
Section 3-101 | ||||||
36 | of the Code of Civil Procedure. The provisions of the
|
| |||||||
|
|||||||
1 | Administrative
Review Law shall apply to and govern all
| ||||||
2 | proceedings for the judicial review of final | ||||||
3 | administrative decisions of the
board.
| ||||||
4 | (7) If an insurer fails to appeal an assessment in | ||||||
5 | accordance with the
provisions of this subsection, the | ||||||
6 | insurer shall be deemed
to have waived its right of appeal.
| ||||||
7 | The provisions of this subsection apply to all assessments | ||||||
8 | made in any
calendar year ending on or after December 31, 1997.
| ||||||
9 | (Source: P.A. 90-30, eff. 7-1-97; 90-567, eff. 1-23-98.)
|